Andrew Vickers

Very common to ask patients to rate pain from "no pain" (0) to "worst pain imaginable / possible" (10). Here is a randomized trial showing anchor for pain score of 10 should be "extreme pain" (TL;DR: we want to evaluate pain, not imagination) pmc.ncbi.nlm.nih.gov/articles/PMC...

Guidelines group argues against lymph node dissection in radical prostatectomy by cherry-picking outlying studies eg systematic review finds 5 studies on lymphedema only 1 with p<5%; authors cite that one study and ignore systematic review. www.europeanurology.com/article/S030...

Sepsis prediction not my field, but my anecdotal experience is that these models not well validated in the first place and don't work well in practice. Clinicians pick up on that and don't trust the model.

It is the power of ideology. Fight it.

UK woman who refused cancer drugs was influenced by mother, inquest finds Paloma Shemirani, 23, died after refusing chemotherapy for non-Hodgkin lymphoma despite doctors’ concerns

All wrapped up in a neat little bow. Covid conspiracy theorist encourages her lymphoma afflicted daughter to refuse chemotherapy. The daughter dies. The mother blames paramedics for the death. www.theguardian.com/society/2025...

Assessing the oncologic risk when systematic and multiparametric magnetic resonance imaging-targeted prostate biopsy grade groups are discordant AbstractBackground and Objective. In the systematic biopsy (SBx) era, prostate biopsy grading followed the rule that the ISUP grade group (GG) assigned was

Large multicenter study: "When grade group discordant between systematic & targeted biopsy, risk is intermediate. Current approach assigning highest grade should be abandoned ... consider de-escalating treatment when grade discordant." academic.oup.com/jnci/advance...

This has a long history: see Hofstadter on the paranoid style.

My theory of medical evidence is simple: observational studies for me, RCTs for you.

Prostate-specific antigen levels at age 60 and lifetime risk of lethal prostate cancer AbstractIntroduction. We investigated the natural history of the relationship between PSA at age 60 and lifetime risk of prostate cancer death in an unscre

Remarkable study from the Malmo Preventive Project: ~1000 men with blood at 60 in 1981; no PSA screening, *lifetime* follow-up. >50% life years lost to prostate cancer in PSA>4.0; 85% for PSA >2.0. Focus screening for men in 60s in men with higher PSAs! academic.oup.com/jnci/advance...

Now seen two papers claiming PLND not needed in a subgroup with relatively low incidence of positive nodes at radical prostatectomy. Neither cite the RCT showing benefit of PLND. When RCT says “do X”, don’t eyeball a case-series to conclude “don’t do X”.

yes, in the paper!

Most common pitfall: ignoring it entirely!

@richarddriley.bsky.social

Guidelines for Meta-analyses and Systematic Reviews in Urology Our guideline comprises points addressing the conduct and interpretation of systematic reviews and meta-analyses in urology. Application of the guideline would lead to a more considered interpretation...

This is big! Worked with great statisticians on guidelines for meta-analysis & systematic review. We discuss rationales for systematic review, evaluation & interpretation of heterogeneity, & common errors in network meta-analysis, funnel plots etc. www.europeanurology.com/article/S030...

exactly so! ANCOVA great for experimental, not always appropriate for observational. If your question is "does regimen A or B build strength faster?" and you e.g. randomized to A vs. B, your question is "if you started at a given strength level, would A or B make you stronger".

It is not about bias, it is about the question you are asking. ANCCOVA asks the question "would increases in strength from training be the same in men vs. women if it were true that men and women had the same strength at baseline?". I don't find that a very interesting question.

How Do Urologists Interpret Risk? Differences in Appropriateness of Active Surveillance Based on Clinical-Based vs Probability-Based Risk Assessments | Urology Practice

Urologists do well with probability estimates vs. clinical scenarios. Goes against 25 years of me hearing "clinicians are too dumb to understand numbers, just tell them what to do". doi.org/10.1097/UPJ....

Quantification of prostate cancer Gleason pattern 4 to predict oncological outcome Objectives To determine if quantifying Gleason pattern 4 (GP4) is superior to Grade Group (GG) in predicting any and distant metastatic recurrence after radical prostatectomy (RP) for prostate cance...

Thrilled to share our new @BJUIjournal study!
📊 Quantifying Gleason pattern 4 via MRI & targeted biopsy predicts prostate cancer metastasis better than standard Gleason grading & risk scores.
Precision matters in risk stratification.
🔗 doi.org/10.1111/bju.... @vickersbiostats.bsky.social

No.

I've used that analogy for several years! Great that my elders and betters got there first!

I'm pretty sure this has been documented, but you could probably do the appropriate search better than I.

Talk to any psychologist working in a cancer center and the will tell you that they routinely deal with patients thinking it is their own fault, or worrying that they have to "think positive".

It isn't really a case of "I read Eysenck and now I feel guilty". But Eysenck was a prime mover in what became a host of books, magazine article and scientific papers claiming that the origin of cancer was influenced by the mind (eg stress) & that attitude affects survival (fighting attitude = good)

Interesting to see. Ronald Grossarth-Maticek is responsible for so much suffering, cancer patients believing that somehow their diagnosis and death was their own fault.

Completely agree with you! That was part of the point of my post!

Hans Eysenck - Wikipedia

Folks discuss replication crisis as if something new. But remember Hans Eysenck (an OG scientific racist)? Both "Eysenck was the most frequently cited living psychologist" & "14 papers retracted, 60 statements of concern issued by journals"
en.wikipedia.org/wiki/Hans_Ey...

Elderly people being excluded from medical research in UK, charities warn The exclusion of older people from research due to arbitrary age cut-offs could stall the development of life-saving treatments

No justification for arbitrary age cut-offs in clinical trials (e.g. excluding patients over 75) www.theguardian.com/society/2025...

John I-need-to-say-this is a living embodiment of using bad science to criticize others for their bad science.

Reply to Matthew J. Roberts, Philip Cornford, Derya Tilki. Oncological Benefits of Extended Pelvic Lymph Node Dissection: More Fog or Clarity to the Debate? Eur Urol 2025;87:261–3

A comment on some invalid criticisms of the radical prostatectomy lymph node dissection trial www.sciencedirect.com/science/arti...

98% of humans that have ever referred to a p-value don't have the slightest fucking clue what they are talking about.